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In patients with ACS undergoing CABG, ticagrelor confers similar risk for bleeding vs. aspirin
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Patients with ACS prescribed ticagrelor with or without aspirin prior to CABG had a similar risk for bleeding, but more risk for platelet transfusion, compared with patients receiving aspirin alone, researchers reported.
Risk for severe bleeding significantly increased among patients in whom ticagrelor (Brilinta, AstraZeneca) was not discontinued at least 2 days prior to surgery, but there was no difference in severe bleeding between the regimens if ticagrelor was stopped 2 days before surgery or earlier, the researchers wrote.
Riccardo Gherli, MD, and colleagues conducted a propensity score–matched analysis that included data on 786 adult patients from the E-CABG registry who underwent CABG between January and September 2015. Patients (mean age, 67 years; 17% women) were prescribed preoperative ticagrelor with or without aspirin, or aspirin alone.
Propensity-score matching resulted in 215 pairs with similar baseline and operative covariates. Criteria from the Universal Definition of Perioperative Bleeding (UDPB) and E-CABG bleeding classification were used to define the primary outcome of severe bleeding.
Compared with those given aspirin alone, patients prescribed preoperative ticagrelor had a similar risk for bleeding according to the UDPB and E-CABG criteria, the researchers wrote.
However, the incidence of platelet transfusion was greater in patients who were prescribed ticagrelor compared with those prescribed aspirin (13.5% vs. 6%; P = .009); the ticagrelor group received a mean of 0.5 U (standard deviation, 1.8) vs. 0.1 U for the aspirin-alone group (standard deviation, 0.4; P = .006), the researchers wrote.
Those in the ticagrelor group who did not discontinue use less than 2 days prior to surgery had increased risk for platelet transfusion (22.7% vs. 6.4%; P = .008), higher rates of E-CABG bleeding grades 2 and 3 (18.2% vs. 5.9%; P = .03) and a greater risk for UDPB grades 3 and 4 (22.7% vs. 9.6%; P = .06) compared with the aspirin-alone group, according to Gherli, from the department of cardiovascular sciences, cardiac surgery unit, San Camillo Forlanini Hospital, Rome, and colleagues.
When ticagrelor was discontinued at least 2 days prior to surgery, the incidence of platelet transfusion was 12.4% compared with 3.6% in patients that only received aspirin (P = .22).
“Larger data sets and randomized clinical trials are needed to assess whether patients with ACS receiving ticagrelor are at higher risk of adverse events while waiting for CABG and whether they may safely undergo coronary surgery after such a short discontinuation of ticagrelor use,” the researchers wrote. – by Suzanne Reist
Disclosure: One researcher reports receiving a lecture fee from AstraZeneca.
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